RIORGANIZZAZIONE DELL'AMBULATORIO DI PREVENZIONE DEL PIEDE DIABETICO: L'INSERIMENTO DEL PODOLOGO NEL PERCORSO ASSISTENZIALE DELL'ASL2 DI LUCCA

CAPITOLO 1 1.1 IL DIABETE Il diabete è un disordine metabolico ad eziologia multipla, caratterizzato da un’iperglicemia cronica, con disturbi del metabolismo di carboidrati, lipidi e proteine, conseguente ad una alterazione della secrezione o dell’azione dell’insulina. Viene classificato in base al tipo di deficit dell’insulina. L'attuale classificazione suddivide il diabete in 4 classi cliniche [1]: • DIABETE DI TIPO 1: colpisce prevalentemente l’età adolescenziale ed è caratterizzato da una carenza assoluta di insulina, con la variante Latent Autoimmune Diabetes in Adult (LADA). In questa classe sono presenti due varianti, quella idiopatica e quella su base autoimmune, che determinano entrambe la distruzione delle β-cellulare. I sintomi presenti sono: poliuria, polidipsia e polifagia paradossa (il paziente mangia molto, ma dimagrisce), spesso eclatanti e con un inizio spesso brusco. E’ necessaria la terapia insulinica fin dall’inizio. Rappresenta circa l’8% dei casi con prevalenza compresa tra 0.4 e 1 ‰ ; • DIABETE DI TIPO 2: causato da un deficit parziale di secrezione insulinica, più o meno severa, che in genere progredisce nel tempo, ma non porta mai a una carenza assoluta di ormone. La sintomatologia può essere assente. La terapia consiste in modifiche della dieta, farmaci orali, analoghi GLP-1 ed insulina. Rappresenta l’85-90% di tutti i diabetici nei Paesi sviluppati con prevalenza intorno al 3-4%. La percentuale aumenta nei Paesi in via di sviluppo e a ciò hanno contribuito il progressivo invecchiamento della popolazione, modifiche negli stili di vita e una non corretta alimentazione; • ALTRI TIPI DI DIABETE: il monogenico, causato da difetti genetici che alterano secrezione e/o azione insulinica (es. MODY, diabete lipoatrofico, diabete neonatale) con prevalenza del 5%, ed il secondario, conseguenza di patologie che alterano la secrezione insulinica (es. pancreatite cronica o pancreasectomia) o l’azione insulinica (es. acromegalia o ipercortisolismo) o l’uso cronico di farmaci (es. steroidi, antiretrovirali, antirigetto) o l’esposizione a sostanze chimiche; • DIABETE GESTAZIONALE: diagnosticato in gravidanza e che in genere regredisce dopo il parto, ma che può comunque ripresentarsi a distanza di anni con le caratteristiche del diabete tipo 2

Epstein-barr virus induced cellular changes in nasal mucosa

A 21-year-old man presented with nasal obstruction of the right nasal fossa of 1 year duration. Nasal endoscopy revealed in the right inferior turbinate head a rounded neoplasm about 1 cm in diameter. Cytologic study of a nasal scraping specimen disclosed numerous clusters containing columnar cells with cytomegaly, prominent multinucleation, markedly sparse shortened cilia; the cytoplasm contained an acidophil area and a small round area that stained poorly; cells with a large intracytoplasmic vacuole that was acidophil and PAS+. Serology tests using the nested polymer chain reaction (PCR) technique on serum, nasal and pharyngeal smears revealed an Epstein-Barr virus (EBV) infection that was confirmed at electron microscopy. The clinical and cytological features resolved 19 months after the initial evaluation. CONCLUSION: The authors advise carrying out clinical (endoscopy, serology, etc.) evaluation of all endonasal neoplasms and to routinely perform cytological study on nasal scraping specimens. When samples test positive for EBV, nasal and nasopharyngeal endoscopy should be performed regularly to detect possible evidence for nasopharyngeal carcinoma (NPC)

Acoustic pharyngometry: clinical and instrumental correlations in sleep disorders

Summary Matteo Gelardi 1 , Alessandro Maselli del Giudice 2 , Francesco Cariti 3 , Michele Cassano 4 , Aline Castelante Farras 5 , Maria Luisa Fiorella 6 , Pasquale Cassano 7 1 ENT specialist (Physician of the Bari University Otorhinolaryngology Department - Italy) 2 Physician (ENT Resident - Bari University - Italy) 3 Physician (ENT Resident - Bari University - Italy) 4 ENT specialist (Researcher of the Foggia University Otorhinolaryngology Department - Italy) 5 ENT specialist (Fellow of the Foggia University Otorhinolaryngology Department - Italy) 6 ENT specialist (Researcher of the Bari University Otorhinolaryngology Department - Italy) 7 ENT and Audiology specialist (Head of the Foggia University Otorhinolaryngology Department and Full Professor of Otorhinolaryngology at Foggia University - Italy)Bari University - Italy; Foggia University - ItalyDr. Michele Cassano Via: Crispi 34/C CEP: 70123 Bari - Italy. Telephone: 00xx39-080-5235508/ 00xx39-3388105268 Fax: 00xx39-080-5211318. Dra. Aline Castelante Farras Rua Sete de Setembro, 676 Centro Vila Velha - ES Telefone: 27-32393661 E-mail: [email protected] [email protected] Paper submitted to the ABORL-CCF SGP (Management Publications System) on July 29th, 2005 and accepted for publication on November 3th, 2006. cod. 567

The Association between Cognitive Impairment and Diabetic Foot Care : Role of Neuropathy and Glycated Hemoglobin

Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician's recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac > 7%) significantly (p 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician's recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged ≥ 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot

Altered Expression of the CB1 Cannabinoid Receptor in the Triple Transgenic Mouse Model of Alzheimer's Disease

The endocannabinoid system has gained much attention as a new potential pharmacotherapeutic target in various neurodegenerative diseases, including Alzheimer's disease (AD). However, the association between CB1 alterations and the development of AD neuropathology is unclear and often contradictory. In this study, brain CB1 mRNA and CB1 protein levels were analyzed in 3 × Tg-AD mice and compared to wild-type littermates at 2, 6 and 12 months of age, using in-situ hybridization and immunohistochemistry, respectively. Semiquantitative analysis of CB1 expression focused on the prefrontal cortex (PFC), prelimbic cortex, dorsal hippocampus (DH), basolateral amygdala complex (BLA), and ventral hippocampus (VH), all areas with high CB1 densities that are strongly affected by neuropathology in 3 × Tg-AD mice. At 2 months of age, there was no change in CB1 mRNA and protein levels in 3 × Tg-AD mice compared to Non-Tg mice in all brain areas analyzed. However, at 6 and 12 months of age, CB1 mRNA levels were significantly higher in PFC, DH, and BLA, and lower in VH in 3 × Tg-AD mice compared to wild-type littermates. CB1 immunohistochemistry revealed that CB1 protein expression was unchanged in 3 × Tg-AD at 2 and 6 months of age, while a significant decrease in CB1 receptor immunoreactivity was detected in the BLA and DH of 12-month-old 3 × Tg-AD mice, with no sign of alteration in other brain areas. The altered CB1 levels appear, rather, to be age-and/or pathology-dependent, indicating an involvement of the endocannabinoid system in AD pathology and supporting the ECS as a potential novel therapeutic target for treatment of AD

Clinical-Cytological-Grading and phenotyping in patients with chronic rhinosinusitis with nasal polyps: the relevance in clinical practice

Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients

COVID-19: When dust mites and lockdown create the perfect storm

The aim of the present study was to understand if the course of the disease of patients suffering from dust mite allergy could have been negatively affected by the COVID-19 restrictions, which have been certainly important to fight the pandemic, but forced patients to stay at home for a long time

A faringometria acústica: correlações clínico-instrumentais nos distúrbios do sono

A faringometria acústica representa um método atual baseado no principio físico da reflexão acústica, útil à análise volumétrica do espaço orofaringolaringotraqueal. OBJETIVO: Este estudo se propõe a avaliar as variações dos parâmetros faringométricos em indivíduos portadores de distúrbios respiratórios do sono (DRS), para estabelecer uma relação entre as variações morfovolumétricas do espaço orofaringolaríngeo e a existência e gravidade da patologia. FORMA DE ESTUDO: Clínico e experimental. MATERIAL E MÉTODO: Foram examinados 110 pacientes, 70 com DRS e 40 normais, durante o período de Junho/04 a Junho/05. Todos os pacientes foram submetidos à faringometria acústica que permitiu uma avaliação da área oro e hipofaríngea através de um gráfico explicativo. RESULTADOS: Os parâmetros obtidos nos pacientes com DRS mostraram uma importante diferença com respeito ao grupo controle, principalmente na amplitude da I onda (significantemente menor nos pacientes com macroglossia), na extensão do segmento OF, na amplitude do segmento OF e na área hipofaríngea. COLCLUSÃO: A faringometria acústica, mesmo não sendo uma técnica padronizada, pode auxiliar no diagnóstico das síndromes obstrutivas do sono, na localização dos possíveis pontos de obstrução e da gravidade da patologia, e no monitoramento dos pacientes submetidos a cirurgias desobstrutivas das vias aéreas superiores

Dysphagia in non-intubated patients affected by COVID-19 infection

Purpose Patients affected by COVID-19 are assumed to be at high risk of developing swallowing disorders. However, to our best knowledge, data on the characteristics and incidence of dysphagia associated with COVID-19 are lacking, especially in non-intubated patients. Therefore, we investigated the onset of swallowing disorders in patients with laboratory-confirmed COVID-19 infection who have not been treated with invasive ventilation, in order to evaluate how the virus affected swallowing function regardless of orotracheal intubation. Methods We evaluated 41 patients admitted to the COVID department of our Hospital when they had already passed the acute phase of the disease and were therefore asymptomatic but still positive for SARS-CoV-2 RNA by RT-PCR. We examined patients' clinical history and performed the Volume-Viscosity Swallow Test (VVST). Each patient also answered the Swallowing Disturbance Questionnaire (SDQ). After 6 months, we performed a follow-up in patients with swallowing disorders. Results Eight of 41 patients (20%) presented with dysphagia symptoms during hospitalization and 2 of them (25%) still presented a SDQ high score and swallowing disorders with liquid consistency after 6 months. Conclusion Non-intubated patients can experience various grades of swallowing impairment that probably directly related to pulmonary respiratory function alterations and viral direct neuronal lesive activity. Although these symptoms show natural tendency to spontaneous resolution, their impact on a general physical impaired situation should not be underestimated, since it can adversely affect patients' recovery from COVID-19 worsening health outcomes

Complete Metabolic Response with Recanalization of Portal Vein Tumor Thrombosis after Sunitinib in a Patient with Advanced Hepatocellular Carcinoma

The prognosis of patients with advanced hepatocellular carcinoma (HCC) is very poor. The outcome of these patients is particularly bleak when the disease is complicated by portal vein tumor thrombosis (PVTT), since the increased portal pressure often causes serious gastrointestinal bleedings. Before the introduction of sorafenib (SOR), a tyrosine kinase inhibitor, no effective treatment was available for patients with advanced disease. SOR is now considered the standard treatment even for patients with tumor thrombosis, although the well-known interference between tyrosine kinase inhibitors and the coagulation pathway calls for caution against their use in this setting. Here, we report the case of a 74-year-old male patient with advanced HCC and PVTT treated with sunitinib (SUN), another multikinase inhibitor. During the third cycle, our patient experienced a life-threatening hematemesis with hemorrhagic shock that required intensive care treatment and SUN discontinuation. However, he completely recovered, and the PET/CT scan performed 1 year after the adverse effect demonstrated no evidence of the tumor together with portal vein recanalization. The short course of SUN causing both tumor response and gastrointestinal bleeding warrants further studies on the effectiveness of SUN in this setting as well as on the duration of treatment with multikinase inhibitors in patients with tumor thrombosis